MEDICARE: NOELLE GERARD KRUEGER RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN00138511	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN00138511	OTHER	WA	RN LICENSE

General Provider Information

NPI Number	:	1043952773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOELLE GERARD KRUEGER RN

Provider Business Mailing Address
First Line	:	5206 64TH AVE NW
Second Line	:
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-6642
Country	:	US
Telephone Number	:	253-278-0393
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 15TH ST SW # 10021
Second Line	:
City	:	AUBURN
State	:	WA
Zip	:	98001-6502
Country	:	US
Telephone Number	:	253-278-0393
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2022
Last Update Date	:	04/12/2022

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